ON THE ACCURACY OF HISTORY, PHYSICAL-EXAMINATION, AND ERYTHROCYTE SEDIMENTATION-RATE IN DIAGNOSING LOW-BACK-PAIN IN GENERAL-PRACTICE - A CRITERIA-BASED REVIEW OF THE LITERATURE

Study Design, A criteria-based review of the literature was conducted regarding the accuracy of history, physical examination, and erythrocy te sedimentation rate in diagnosing low back pain. Objectives. To perf orm mete-analysis of the literature regarding signs and symptoms in di agnosing radiculopathy ankylosing spondylitis, and vertebral cancer. S ummary of Background Data. Diagnosing low back pain, especially in gen eral practice, depends largely on history taking, physical examination , and the erythrocyte sedimentation rate. No previous review has asses sed the diagnostic accuracy of signs and symptoms in a systematic way, taking into account the methodological quality of studies. Methods. T he literature was reviewed for relevant studies. Retrieved studies wer e independently rated for methodological quality by two reviewers. The reported sensitivity and specificity in the rated studies were review ed. Results. Thirty-six eligible studies were retrieved. Major methodo logical shortcomings were observed, and only 19 studies scored greater than or equal to points (maximal score 100). Not one single test appe ared to have high sensitivity and high specificity in radiculopathy. T he combined history and the erythrocyte sedimentation rate had relativ ely high diagnostic accuracy in vertebral cancer. Getting out of bed a t night and reduced lateral mobility seemed to be the only moderately accurate items in ankylosing spondylitis. Conclusions. Additional stud ies that take into account the shortcomings identified would be needed to produce definite conclusions. Few of the studied signs and symptom s seemed to be valuable diagnostics for radiculopathy, ankylosing spon dylitis, and vertebral cancer. Reproducibility of signs and symptoms o ver time might be a valuable diagnostic criterion. However, this was n eglected in almost all studies.